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Community Approaches to Caring for Uninsured People

Health Affairs Article Spotlights Activities in 12 Communities

WASHINGTON, DCFaced with rising uninsurance rates
and little response from state and federal governments, local communities have
developed a range of approaches to provide care to uninsured people, according
to a study by the Center for Studying Health System Change (HSC) published today
as a Web-exclusive in the journal Health Affairs.

In "Community Approaches to Providing Care for the Uninsured," based
on research conducted as part of HSCs Community Tracking Study (CTS), researchers
identified four main approaches to providing care to the uninsured: donated-care
programs; discounted care programs; managed care safety net programs; and limited-benefit
coverage programs. Community-based programs "are often invaluable to those
who are able to enroll," but they tend to "serve only a small proportion
of their communitys uninsured residents, barely making a dent in the overall
problem," according to the study by Erin Fries Taylor, a researcher at
Mathematica Policy Research and an HSC consulting researcher, HSC Senior Researcher
Peter Cunningham and HSC Research Assistant Kelly McKenzie.

The difficulties that local leaders face are the same as those that hinder
progress at the federal level: money and politics. "Community programs
in the CTS sites increasingly are clustered around private-sector strategies,
likely because public resources targeted specifically to programs for the uninsured
have become more constrained in recent years," Taylor, Cunningham, and
McKenzie note. "Greater reliance on the private sector seems to be limiting
the scope of these programs in terms of the number of uninsured people served,
compared with the managed care programs of the 1990s that could tap into substantial
public funds and pursue ambitious enrollment goals."

The Center for Studying Health System Change is a nonpartisan policy research
organization committed to providing objective and timely research on the nations
changing health system to help inform policy makers and contribute to better
health care policy. HSC, based in Washington, D.C., is funded principally by
The Robert Wood Johnson Foundation and is affiliated with Mathematica Policy
Research, Inc.